This policy brief from the Robert Wood Johnson Foundation and Health Affairs examines the decisions that states are making in either establishing state-based health insurance exchanges, engaging in partnership exchanges with the federal government, or inviting federally-facilated exchanges under the Patient Protection and Affordable Care Act. Among the key issues that each state must resolve are questions about the degree of regulation and control over health insurance in their state, consumer outreach and enrollment, coordination across other state programs such as Medicaid and the Children’s Health Insurance Program, and funding and other resources to sustain the exchanges. The policy brief was written by the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms.